WebMD Health - Pain Management

Feb 25, 2011 5:46 PM

Sex and Chronic Pain

Maryann Lowry was 42 years old in 1995, when she woke up one morning with severe pelvic pain. She was diagnosed with vulvodynia -- which literally just means severe pain in the vulvar area. Today, 14 years later, she says that she's "95% recovered" -- but the many years of dealing with chronic pain took its toll on her relationships, her personal life, and of course, her sex life.

"I thought, how am I going to keep my marriage together if I can't have sex? It was more of a gift that I tried to give my husband until I could feel better," she recalls.

Lowry is far from alone. According to the American Pain Foundation, as many as 50 million Americans have chronic pain, stemming from causes ranging from cancer treatment to back injuries to fibromyalgia and many more.And almost 80% of people living with chronic pain and/or disability and their partners report a significant reduction or loss of their sexual functioning.

Chronic pain can lead to fatigue, insomnia, and symptoms of depression. Pain medicines may reduce libido. And for some people, intercourse itself can cause pain, says Meeru Sathi-Welsch, MD, an anesthesiologist and pain specialist with Long Island Neuroscience Specialists.

"Chronic pain infuses every aspect of a person's life," agrees Daniel Kantor, MD, president-elect of the Florida Society of Neurology (FSN) and Medical Director of Neurologique, an organization dedicated to patient care, research and education. "You don't see yourself as a romantic, sexual being, because you're so defined by the pain."

How to Get Your Groove Back

What can you do to light the fires again? "It takes a lot of creativity and patience!" says Sherrie Sisk, 43, a single mom who chronicles her 10-year struggle with fibromyalgia pain in a blog called "The Tramadol Diaries."

First, talk to your doctor about what aspects of your treatment might be changed to help improve things sexually. David Rosenfeld, MD, a pain specialist with the Atlanta Pain Center, says your doctor can help in several ways:

  • Change medications. "We can decrease opiates and use more other medications that we know are effective for treating chronic pain with less effect on sexuality, like Cymbalta and Lyrica," says Rosenfeld.
  • Add new medications. For men with low testosterone levels, a prescription for testosterone may help with sexual desire. Drug treatments such as Cialis, Levitra, and Viagra may also be used for men with erectile dysfunction.
  • Refer you for biofeedback treatments. "We've found that biofeedback can be very helpful for women, in particular, who complain of significant pelvic pain and dyspareunia," says Rosenfeld. Dyspareunia is pain with sexual intercourse.
  • Connect you with a support group. It can help to know that you're not alone -- and other people in the same boat might have new ideas you haven't tried.

Get Creative About Sex

Don't think of sex in the same way you always did. The positions that worked for you before you began your struggle with chronic pain may not work for you now. You may need to think of new ways to initiate intimacy and different ways to be intimate.

  • Change positions. Especially if you have severe back pain or neck pain, being on the bottom -- or the top -- could be painful. Try a side-to-side position to alleviate back or neck pressure; use pillows for support.
  • Take your time. Instead of just initiating sex, sit quietly by the fireplace with your partner and read a romantic or sexy book to each other. "This is time for you as a couple, not focused on pain," Kantor says. "Hold each other's feet and give your partner a foot massage. Don't be in a rush. After awhile, it becomes not about the pain and not about forcing yourself.
  • Try alternatives to intercourse. "People can try using vibrators, manual stimulation, and other intimate acts besides just intercourse itself," says Sisk. "Go beyond 'You do me and I do you.'"

When you're coping with chronic pain it can be tempting to just write off the sexual part of your life. But that puts your relationship at risk. "If you're not at least willing to explore intimacy with your partner, you're going to be in trouble," Sisk says. "Your partner has to learn what your illness means to you, how it affects your sexuality, and try new things to make it better. And you have to understand that sex is important to your partner. You can't say, 'That part of our life is over now.'"

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